Hemorrhoids

UW Health Colon and Rectal Surgery specialists in Madison, Wisconsin provide comprehensive evaluation and surgical treatment of diseases of the colon, rectum and anus. For patients suffering from severe hemorrhoids, surgical management may offer relief from the symptoms.

Hemorrhoids are one of the most common ailments known, affecting millions of Americans.

Overview of Hemorrhoids

Hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum. There are two types of hemorrhoids:

External

Internal

External Hemorrhoids

External hemorrhoids develop near the anus and are covered by very sensitive skin. These are usually painless. However, if a blood clot (thrombosis) develops in an external hemorrhoid, it becomes a painful, hard lump. The external hemorrhoid may bleed if it ruptures.

Internal Hemorrhoids

Internal hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely "prolapsed" - protrudes from the anal opening and cannot be pushed back inside.

Causes of Hemorrhoids

An exact cause is unknown, but contributing factors include:

Aging

Chronic constipation or diarrhea

Pregnancy

Heredity

Straining during bowel movements

Faulty bowel function due to overuse of laxatives or enemas

Spending long periods of time (e.g., reading) on the toilet

The tissues supporting the vessels of the anus stretch. As a result, the vessels dilate; their walls become thin and bleed. If the stretching and pressure continue, the weakened vessels protrude.

Symptoms of Hemorrhoids

Common symptoms of hemorrhoids include:

Bleeding during bowel movements

Protrusion during bowel movements

Itching in the anal area

Pain

Sensitive lump(s)

Hemorrhoid Treatments

Mild symptoms can be relieved frequently by:

Increasing the amount of fiber (e.g., fruits, vegetables, breads and cereals) and fluids in the diet

Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding

A sitz bath - sitting in plain warm water for about 10 minutes - can also provide some relief

With these measures, the pain and swelling of most symptomatic hemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks.

In cases of severe or persistent pain from a thrombosed hemorrhoid, your physician may remove the hemorrhoid with a small incision. The procedure is performed under local anesthesia on an outpatient basis.

Severe hemorrhoids may require special treatment, including:

Ligation

Also called the rubber band treatment, Ligation is used on internal hemorrhoids that protrude with bowel movements. A small rubber band is placed over the hemorrhoid, cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding and may need to be repeated for a full effect.

Injection and Coagulation

Injection and coagulation can also be used on bleeding hemorrhoids that do not protrude. Both methods are relatively painless and cause the hemorrhoid to shrivel up.

Hemorrhoid Stapling

Hemorrhoid stapling uses a special device to internally staple and remove internal hemorrhoidal tissue. The stapling method does not remove external hemorrhoids, but may cause them to shrink. This procedure is generally more painful that rubber band ligation and less painful than hemorroidectomy.

Hemorrhoidectomy

A hemorrhoidectomy is the surgical removal of the hemorrhoids. It is the most complete method for removal of internal and external hemorrhoids. A hemorrhoidectomy is often necessary when:

Clots repeatedly form in external hemorrhoids

Ligation fails to treat internal hemorrhoids

The protruding hemorrhoid cannot be reduced

There is persistent bleeding

A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia using either sutures or staplers, and may, depending upon circumstances, require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful.

Hemorrhoids and Cancer

There is no relationship between hemorrhoids and cancer. However, the symptoms of hemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other diseases of the digestive system. Therefore, it is important that all symptoms are investigated by a physician specially trained in treating diseases of the colon and rectum and that everyone 50 years or older undergo screening tests for colorectal cancer. Do not rely on over-the-counter medications or other self-treatments. See a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed.